Laparoscopic surgery is a procedure in which surgical instruments and a viewing scope, referred to generally as an endoscope and more specifically as a laparoscope, are inserted through small puncture wounds or incisions into the abdominal cavity of a patient. A small video camera is attached to the laparoscope and connected to a television monitor for viewing the procedure.
The instruments and the laparoscope are inserted through cannulae which are first inserted through the incisions. Cannulae are hollow tubes with gas valves. The cannulae are left in the puncture wounds throughout the procedure. This allows the instruments and scope to be removed and reinserted as necessary.
To aid in visualizing the intra-abdominal structures, gas is inserted through one of the cannulae to raise the abdominal wall. Seals are required at the exit points of the scope and instruments to prevent the gas from escaping.
The viewing laparoscope is inserted through a cannula which is usually inserted through an incision made in the umbilicus. The scope is then directed toward the pelvis for pelvic surgery or toward the liver for gallbladder surgery.
Throughout the procedure it is necessary for the surgeon, assistant surgeon, or a scrub nurse to hold the scope and direct it at the target of the surgery. It is constantly being repositioned to obtain the best view. This process ties up one hand of the surgeon or assistant surgeon, if either holds the scope. The scrub nurses also have other tasks to perform, and holding the scope interferes with performing these tasks. It is also difficult for the surgeon to direct others to position the scope for the best view. When the scope is not held by the surgeon, it is often misdirected.
The support of a laparoscope has been provided through the use of robotic retractors. Retractors hold instruments in fixed positions, such as for holding an incision open to allow a surgeon access to the underlying body parts. The retractors are fixedly clamped to a mechanical skeleton. This skeleton has also been used to hold a laparoscope in a fixed position. When it is desired to move the scope, the clamp must be readjusted, and usually the skeleton linkages must also be adjusted to accommodate a change in the angle of insertion of the laparoscope.
U.S. Pat. No. 5,571,072 ('072) discloses a cannula and an associated endoscope secured to an operating table by a mechanical linkage assembly having linear and angular connections. These connections are adjustable for supporting an endoscope extending through an incision. According to '072, two angular connections are friction joints that allow manual repositioning of the scope by pivoting about respective orthogonal axes that intersect at a point along the scope that is coincident with the location of the incision.
U.S. Pat. No. 7,048,745 ('745) teaches surgical tool robotic manipulator. As taught by '745 embedded computer means can perform a number of functions when the tool is loaded on the tool manipulator: (1) providing a signal verifying that the tool is compatible with that particular robotic system; (2) identifying the tool-type to the robotic system so that the robotic system can reconfigure the programming; or (3) indicating tool-specific information, including measured calibration offsets indicating misalignment of the tool drive system, tool life data, or the like.
Patent Application WO2006111966 ('966) to the inventor, which is incorporated as a reference, discloses a computerized system enabling operative precise positioning laparoscopic surgical tools. The system comprises a manipulator providing displacement in four degree of freedom. The system consists of two main components: the first part has an arc shape in which the endoscope can be driven back and forth and at the same time can be moved from side to side; the second part is characterized by zoom and rotation properties.
Laparoscopic orthopedic surgeries differ from abdominal laparoscopic surgeries in their dynamic nature: it is common in orthopedic surgeries to move the limbs of the patient from side to side to bend the knee or the shoulder, or to stretch the patient's joints. Traditional endoscope holders are fixed to the operation table and do not let the endoscope follow the limb movement and therefore are not used in these kinds of procedures. Today, endoscopic orthopedic procedures are performed by the surgeon holding the endoscope in one hand and using a tool in the other hand. When the surgeon needs to use two tools at the same time, he requires an assistant to hold and aim the endoscope for hint. Hence, a system providing rigid fixation of the laparoscope relative to the human limb and laparoscope precise moving, especially a system with four or more degrees of freedom is still a long-felt need.